2016/03/09 by B. P. M. Verhaegh, F. de Vries, A. A. M. Masclee +5
paper · doi:10.1111/apt.13583
Summary Background Microscopic colitis ( MC ) is a chronic bowel disorder characterised by watery diarrhoea. Nonsteroidal anti‐inflammatory drugs ( NSAID s), proton pump inhibitors ( PPI s), selective serotonin reuptake inhibitors ( SSRI s) and statins have been associated with MC . However, underlying mechanisms remain unclear. Aim To study the association between exposure to these drugs and MC , with attention to time of exposure, duration, dosage and combined exposure, and to test hypotheses on underlying pharmacological mechanisms. Methods A case–control study was conducted using the British Clinical Practice Research Datalink. MC cases (1992–2013) were matched to MC ‐naive controls on age, sex and GP practice. Drug exposure was stratified according to time of exposure, duration of exposure or dosage. Conditional logistic regression analysis was applied to calculate adjusted odds ratios ( AOR s). Results In total, 1211 cases with MC were matched to 6041 controls. Mean age was 63.4 years, with 73.2% being female. Current use of NSAID s ( AOR 1.86, 95% CI 1.39–2.49), PPI s ( AOR 3.37, 95% CI 2.77–4.09) or SSRI s ( AOR 2.03, 95% CI 1.58–2.61) was associated with MC compared to never or past use. Continuous use for 4–12 months further increased the risk of MC . Strongest associations (fivefold increased risk) were observed for concomitant use of PPI s and NSAID s. Statins were not associated with MC . Conclusions Current exposure to NSAID s, PPI s or SSRI s and prolonged use for 4–12 months increased the risk of MC . Concomitant use of NSAID s and PPI s showed the highest risk of MC . Acid suppression related dysbiosis may contribute to the PPI effect, which may be exacerbated by NSAID ‐related side‐effects.